| NPI | 1245584887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 169363) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AK 142152) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC21857) | |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2025-08-13 |